by Alison Karnes, M.A.
bSci21 Guest Author
For years, parents and other stakeholders have experienced the difficulty associated with toilet training. Parents of children with disabilities may find toilet training even more challenging, leading to many individuals with disabilities remaining incontinent throughout their lives. Interestingly, the longer one uses a diaper instead of the toilet, the greater the reinforcement history for using the diaper instead of the toilet, and the more challenging it will be to implement a toilet training procedure. Being a biological function, it is clear that excretion is maintained by automatic reinforcement and that a child’s toiling behaviors will occur whether or not the child uses the toilet. Therefore, using the toilet instead of a diaper or pull-up might be maintained by additional reinforcement such as social praise and/or access to tangible items. It is important to eliminate medical causes for incontinence before beginning a toilet training procedure.
The Applied Behavior Analysis program at the University of Arkansas recently provided training for parents of children with disabilities which provided parents tools to improve their children’s independent toileting behaviors. I presented a toilet training procedure that was modified from the research of Azrin and Foxx. Following this experience, it became clear there were many common misconceptions regarding toileting. I have summarized them here:
1. Must remain dry throughout the night. Many parents assume or have been informed that if their children wet the bed at night, toilet training is not an appropriate option. However, children can be independent in their toileting skills during the day but continue to wet the bed at night. For example, a child may be on a two-hour schedule for toilet training throughout the day. Assuming that he or she sleeps for 8-hours, this presents 4 different interval markers at which time the child typically engages in toileting behaviors. The biological nature of sleeping and toileting makes it challenging for parents to establish contingencies overnight. Bedwetting might warrant an additional toilet training procedure in which parents would wake up the child at set intervals in order to provide opportunities throughout the night for the child to use the toilet and to access additional reinforcement for staying dry throughout the night.
2. Must be able to dress self. Because dressing skills are used in the process of completing the behavior chain of using the bathroom, it can be easily misconceived that a child must be independent in his or her dressing skills prior to toilet training. The use of a prompting procedure for a child’s dressing skills remains effective when implementing a toilet training procedure. The child’s dressing skills should be addressed in a program unaffiliated with the toilet training procedure, as the sole focus of toilet training should be toilet training.
3. Must be at a developmental age consistent with typical age to start toilet training. Some might assume that a child who is chronologically 5 years old but is developmentally testing around 2 years old is not a candidate for toilet training. However, because toileting is mostly biologically regulated, this child may be “ready” to begin a toilet training procedure. It is more important to determine if the child is showing signs of readiness for toileting such as, indicating discomfort when wet; remaining dry for over 30 minutes; and showing interest in the toileting behaviors of others. A child may be an appropriate candidate for a toilet training procedure if she is displaying any of these readiness signs.
4. Must be able to initiate toileting needs to parent or other adult. Although this initiation is a sign of readiness, it is not a prerequisite skill. A toilet training protocol can promote independent manding (requesting), if the parent prompts the child to request “potty” or “bathroom” prior to taking the child to use the toilet. After the child is able to remain dry for extended periods, parents may decide to use visual aids to serve as discriminative stimuli for the child to use the toilet when needed.
5. Boys must urinate while standing. When teaching a child to use the toilet, it is important for the child to be provided every opportunity to be successful. For many children, it takes longer to become successful with bowel movements than with urination. When implementing a toilet training protocol with a boy, it is important to have him sit on the toilet for both urination and bowel movements in order to provide multiple opportunities for the child to have a bowel movement in the toilet.
6. Children will outgrow their fears of the bathroom. While this might be true to some extent, a proper behavioral systematic desensitization program should be implemented to decrease the child’s initial fears of the bathroom. Parents can promote familiarity with the bathroom by having the child engage in reinforcing activities in the bathroom, such as watching a movie while sitting on the toilet with a closed lid, playing in the bathtub with swim toys, etc. Once the child’s fears of the bathroom have decreased, the child may be a more acceptable candidate for toilet training.
7. Children should be taught to use a portable potty before transitioning to the toilet. When it comes to toilet training, providing a child every opportunity to be successful was mentioned previously as being an important factor in a successful procedure. Although the practice of using a portable potty before transitioning to the toilet may be successful for some, it may be challenging for others to generalize the use of the portable potty to the use of the toilet. There are many options for child-safe toilet seat attachments, so the child is able to use the toilet from the onset of the training procedure.
In summary, I have addressed several of the misconceptions that parents and other stakeholders have regarding toilet training. Following a behavioral protocol for toileting behaviors is an effective tool used to improve independence in toileting skills for children with disabilities.
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About the author:
Alison Karnes, M.A., is a first-year doctoral student at the University of Arkansas studying Applied Behavior Analysis and Autism Spectrum Disorders. She currently works as a behavioral consultant and manages program quality for a statewide early intervention program, providing behavior analytic treatment to children with Autism. Her research concentration addresses the effects of using iPad technology for improving language development in individuals with Autism Spectrum Disorders and other communication disorders.